In their recent Science paper entitled The Rupture and Repair of Cooperation in Borderline Personality Disorder, King-Casas et al. (2008) examined how well individuals with borderline personality disorder trusted others in an economic exchange game (called, conveniently enough, the Trust Game). In this game, one player (the Investor) gives a sum of money to the other player (the Trustee). The investment triples, and the Trustee decides how much to give back to the Investor. Relative to the control group, the BPD group was more likely to make a small repayment after receiving a small investment. This reflected a lack of cooperation (or "coaxing" behavior) designed to induce the Investors to trust their partners.

For the fMRI portion of the study, the authors bypassed more general analyses comparing BPD and control brains during the point of investment and the point of repayment. Instead, the major neuroimaging result contrasted the receipt of low investment offers vs. high investment offers, as illustrated below. Control brains showed a nearly perfect linear correlation between $ offer and activity in the anterior insula (expressed here as a negative correlation, because low $ offers correlated with high insula activity). Such a relationship was not observed in BPD brains. In fact, no brain region in the BPD group showed a difference between high and low offers.

Fig. 3 (King-Casas et al., 2008). Response of 38 healthy trustee brains and 55 BPD trustee brains to level of cooperation. (Top). Results of within-group GLM[general linear model] analyses identified cortical regions with greater response to small investments (less than or equal to $5) relative to large investments (greater than $10). (Bottom). Percent change in hemodynamic signal was averaged from the 115 most significant voxels identified in the group-level GLM during the 4- to 8-s period following the revelation of investment. The means + SE of the resulting signal are plotted in $4 bins.1 Responses in bilateral anterior insula in healthy trustees scale strongly and negatively with the size of investment (r = –0.97; bottom left). In contrast, similar analyses in individuals with BPD showed no such relation.

The authors linked the insular activation to the detection of social norm violations in interpersonal contexts, concluding that individuals with BPD are deficient in this regard.2 But what are the participants really thinking about during the 4-8 sec interval following a stingy offer? Do we have yet another example of reverse inference here?

Below is a figure generated from entering the x, y, z coordinates from the right insular focus shown above into the Sleuth program (available at brainmap.org), which searched the available database of papers for matches. The resulting list of coordinates and experiments was then imported into the GingerALE program, which performed a meta-analysis via the activation likelihood estimation (ALE) method (see this PDF). The figure illustrates that this exact same region of the right insula was activated during tasks that assessed speech, language, explicit memory, working memory, reasoning, pain, and listening to emotional music.

Perhaps the control subjects in the King-Casas et al. study were muttering to themselves about the stingy offer. Maybe they were engaging working memory processes to a greater extent on those trials. Or maybe they were remembering a time when they were shortchanged at the grocery store. Do we conclude, then, that the BPD subjects did not do any of those things? Or that they engaged those types of processes to an equivalent extent after low and high offers?

To summarize, the extrapolation about the insula and social norm violations was based on a handful of trials from 38 different control participants. I'll leave you with a few questions to ponder. Can the study can really say anything specific about the insular response on those low $ offers? Do we trust that the rest of the brain is completely silent on the matter? We do know that the BPD group scored lower than controls on a self-report measure of trust (the Interpersonal Trust Scale), but do we know what they were really thinking about during the trust game? At the end of the day, does this finding "give psychiatrists a better diagnostic tool and a brain area to target with therapy or drugs when treating BDP"?

What do you think?

Footnotes

1 Note that these 6 monetary bins were formed from a total of 10 trials per dyad.

The essential feature of this disorder is a pervasive pattern of instability of self-image, interpersonal relationships and mood. The person’s sense of identity is profoundly uncertain. Interpersonal relationships are unstable and intense, fluctuating between the extremes of idealisation and devaluation. There is often a terror of being alone, with great efforts made to avoid real or imagined abandonment. Affect is extremely unstable, with marked shifts from baseline mood to depression and anxiety usually lasting a few hours. Inappropriate anger and impulsive behaviour are common, and often this behaviour is self-harming. Suicidal threats and self-mutilation are common in more severe forms of this disorder.

So it's a very serious personality disorder. However, the diagnostic label is a controversial one, coming under fire from feminists (Shaw & Proctor, 2005) and from my favorite psychiatry blog, Shrink Rap. Here's why Dinah doesn't like the label:

I mean, okay, these symptoms cluster in some people, so why don't I like them? Here goes, with no particular rhyme or reason:

The diagnosis (unlike, say, Trichotillomania or Major Depression) is pejorative.

Clinicians are sloppy with the diagnosis and it's not uncommon for a doc to refer to a patient as "a borderline" as a defense--- the patient is difficult to deal with, he's angry or demanding--it's gotta be him, not the doc.

Treatment-wise, many docs avoid these patients and hope runs dry quickly. The prognostic implications are generally not great, these patient don't have rapid and dramatic improvements.

The diagnosis ends up being it's own endpoint, it doesn't leave room for alternate explanations and sometimes patients with Bipolar Disorder look a lot like patients with borderline personality disorder. Oh, while I'm there, patients with Borderline Personality Disorder often have co-morbid Bipolar Disorder (and hey, how about some substance abuse issues thrown in) and if the clinician can get focused on treating the Mood Disorder, sometimes the other noise fades into the background.

It doesn't seem to me that every patient who has these symptoms has them forever in an inflexible way. They come, they go, they change, they get better, they get worse.

With all those caveats in mind, let's look at the lucky 08/08/08 Science paper entitled "The Rupture and Repair of Cooperation in Borderline Personality Disorder." It examines how well individuals with BPD play along with others in an economic exchange game (see also King-Casas et al., 2005, the first of their three Science papers on the topic).

The key participants were 38 controls and 55 people with BPD.1 The vast majority of these participants were female (37 controls, 51 BPD). The two groups were also matched for age and verbal IQ. Each person was paired with another individual (all controls) to play the game, to form a total of 93 dyads.

Who can you trust?

Distrust of others is a cardinal feature of BPD. A history of childhood abuse and neglect is very common in this disorder -- leading to an early rupture of trust that is not easily repaired. A recent paper by Bhar, Brown, and Beck (2008) examined the factor structure of the Personality Beliefs Questionnaire (BPD subscale) and found three major factors: dependency, distrust, and the belief in acting preemptively to avoid threat. All three factors were associated with depression. Dependency and distrust were associated with hopelessness. Distrust, however, was the only factor that was significantly correlated with suicidal ideation.

Thus, assessing trust in BPD patients is a worthwhile endeavor. King-Casas et al. (2008) measured it using the trust game (reviewed in Camerer, 2003).

How does the "trust" game work? (see Read Montague give a brief explanation in Real Player). One player (the Investor) gives a sum of money to the other player (the Trustee). The investment triples, and the Trustee decides how much to give back to the Investor.

You can also read The Neurocritic's previous post on The Trust Game, which discussed the paper by Tomlin, Kayali, King-Casas, et al. (2006).2

I give the authors credit for developing the nifty "hyperscanning" methodology, which involves two subjects who interact with each other while their brains are scanned simultaneously (in adjoining or distant magnets). The task is illustrated below. Brain images are taken at three critical "reveal" points:

The comparison groups in the current experiment played the Trustee role in 10 rounds of the game. The results indicated that in the early rounds, Investors gave BPD and control Trustees similar amounts of money. In the latter 5 rounds of the game, however, there was a decline in the investments given to BPD Trustees but not to control Trustees, because the former weren't as generous with their returns overall. Specifically, the BPD subjects were less likely to use a "coaxing" strategy:

Healthy trustees are twice as likely as BPD trustees to coax when cooperation between players is low. Specifically, healthy trustees are more likely to make a large repayment (greater than or equal to investment amount) after having received a small investment (less than or equal to $5). Conversely, BPD trustees are more likely to make a small repayment (less than the investment amount) after receiving a small investment.

In general, players do not always behave rationally. To maintain higher investments in later rounds, however, coaxing is a beneficial strategy for the Trustee. Maybe levels of the natural "trust drug" oxytocin are low in BPD (ask Paul Zak, or read this PDF), or maybe they just aren't as good at mental arithmetic. Perhaps the BPD propensity to punish low investments could be viewed as analogous to what is seen in the Ultimatum Game (Sanfey et al., 2003) where players reject unfair offers (to their own detriment).

So why do I feel like I'm goin' to lose my mind?3 As suggested by a colleague, the present paper 1) makes liberal use of reverse inference and 2) reeks of fishing.4 In my view, the real trouble arises when the authors try to explain what bits of the brain might be implicated in the lack of trust shown by players with BPD. It's the insula! [and only the insula]. Why is that problematic? We shall return to that question in a moment.

In the study of Sanfey et al., unfair offers were associated with greater activity in bilateral anterior insula, dorsolateral prefrontal cortex, and anterior cingulate cortex, with the degree of insular activity related to the stinginess of the offer. A similar relationship was observed here in the controls, but not in the BPD patients. Taking a step back for a moment, we see differences between control and BPD participants (for the contrast low vs. high investment) in quite a number of places, as illustrated in the table below.

Table S3 (King-Casas et al., 2008). General linear model of Trustee brain regions with greater response to the revelation of small investments (less than or equal to $5) relative to large investments (greater than $10) in healthy Trustees relative to Trustees with BPD. (p less than .05, FDR corrected; min 5 voxels)

However, the within-group analysis in controls yielded a "small investment" effect only in bilateral anterior insula (12 voxels and 15 voxels, respectively, at p less than .10). The same analysis in the BPD group yielded absolutely no significant differences anywhere in the brain! BPD participants react to small stingy investments with differential behavior (by returning a very low percentage of the investment), yet there is no area in the brain telling them to do this. Perhaps something is going on in the delay period between the investment and repayment phases, but if so we don't find out. The authors' interpretation of the null brain effect is that BPD subjects have a social perception problem (as Montague explains here), and do not respond correctly to social norm violations.

The association of the insula with a representation of outcome variance suggests that the insula may encode the distribution of likely outcomes in social interactions; that is, responses in the anterior insula may indicate social norm violations within interpersonal contexts.

When dishing out small returns in the repayment phase, both control and BPD groups show the inverse correlation between insular activity and monetary amount.

...in BPD, the apparent insensitivity of the insula only to offer level size, and not their own repayment, suggests two possibilities: (i) Monetary reward is not reinforcing to individuals with BPD; or, (ii) low offers are not perceived to be a violation of social norms to individuals with BPD.

They rule out the first possibility and go with the second.

But what about the role of dorsal striatum (King-Casas et al., 2005) and ventral tegmental area (Krueger et al., 2007) in the development of trust, or the importance of medial prefrontal cortex and theory of mind [see Mentalizing Mentalizing ]? We do not find out about these, either. Guess we'll have to wait for the next Science paper.

Finally, there's the wildly overblown quotes on the significance of the findings in the popular press:

The finding ... could give psychiatrists a better diagnostic tool and a brain area to target with therapy or drugs when treating BDP, says project leader Read Montague, a neuroscientist at Baylor College of Medicine in Houston.

And this quote, which heralds the dawn of a golden new age of psychiatry:

Peter Bossaerts, a neuroeconomist at Caltech in Pasadena, says that since the games are scored and have a predicted outcome, they may help diagnose mental illnesses.

"This could really revolutionise the way people think about and treat psychiatric illnesses," he says.

Who can you trust?

Footnotes

1 Why those particular numbers? We don't know for sure, but it could be due to the fact that supplementary analyses were run with subgroups of the BPD patients to control for income level and medication status.

2 Oddly (or not), the present King-Casas paper did not even cite their earlier work (Tomlin et al., 2006). The authors appear to have taken the approach of "one brain region, one Science paper." Today it's the insula, in 2006 it was the anterior cingulate cortex, and in 2005 it was the dorsal striatum. How do these brain regions work together to produce the complex behavior in question? Are the three papers even consistent with each other? These issues are not important, apparently.

3 Other than the fact that I am not knowledgeable in behavioral game theory (see Camerer et al., 2003 for that, PDF).

Tuesday, August 19, 2008

Depression may impair driving ability, but we don't really know yet because unmedicated depressed people were not tested in this unpublished study

The truth doesn't make for very exciting PR, now does it?

Let's look at more of the article, starting with the subtitle.

Depressed drivers on meds performed worst in driving simulation

BOSTON – People taking prescription antidepressants appear to drive worse than people who aren't taking such drugs, and depressed people on antidepressants have even more trouble concentrating and reacting behind the wheel.

The first sentence conveys the message that taking antidepressants makes you a worse driver, especially if your symptoms have not remitted. Let's continue.

University of North Dakota psychologists Holly Dannewitz. PhD, and Tom Petros, PhD, recruited 60 people to participate in a driving simulation in which participants had to make a series of common driving decisions, such as reacting to brake lights, stop signs or traffic signals while being distracted by speed limit signs, pylons, animals, other cars, helicopters or bicyclists. The simulation tested steering, concentration and scanning. Thirty-one of the participants were taking at least one type of antidepressant while 29 control group members were taking no medications with the exception of oral contraceptives in some cases.

Do oral contraceptives impair driving? We do not find out.

The group taking antidepressants was further divided into those who scored higher and lower on a test of depression. The group taking antidepressants who reported a high number of symptoms of depression performed significantly worse than the control group on several of the driving performance tasks. But participants who were taking antidepressants and scored in the normal range on a test to measure depression performed no differently than the non-medicated individuals.

So it's very clear that the participants on antidepressants, who were no longer depressed, were not impaired!! The all-important group of unmedicated depressed people was not even tested!

The authors themselves noted:

"Individuals taking antidepressants should be aware of the possible cognitive effects as [they] may affect performance in social, academic and work settings, as well as driving abilities," the researchers wrote. "However, it appears that mood is correlated with cognitive performance, more so than medication use."

But nonetheless we have the ominous conclusion from the APA, warning us about all the impaired female drivers on Prozac:

This research is important in light of the rapid increase in the number of Americans taking antidepressants. Americans' use of antidepressant drugs such as Prozac, Paxil or Zoloft, nearly tripled in a decade, according to the 2004 Health United States report, issued by the National Center for Health Statistics. Among women, one in 10 takes an antidepressant drug, according to the government.

Fortunately (and surprisingly), the popular press didn't swallow the PR hook, line, and sinker. Here's US News & World Report:

AS YOU WATCH the Olympics this week, try to put yourself inside the minds of the network executives who get to decide what to broadcast. Given that you've spent billions on licensing and production costs - meaning that you need the most people from the best advertising demographics to watch - which events and athletes do you highlight? A study out of Clemson University analyzed videotapes of all prime-time Summer and Winter Olympic programming since 1996. Although the Summer Olympics covered men's and women's events about the same, the Winter Olympics was significantly biased toward men's events. The author notes that prominent coverage of women in gymnastics, swimming, diving and, lately, beach volleyball is consistent with the notion "that the Summer Games (offering many events that involve women athletes in swimsuits and leotards) will yield higher clock-time totals than the Winter Games (offering many events that involve women athletes in parkas and other less sexually charged apparel)."

It's not really a surprising insight, but there you go.

In the study, which was published in the journal Television & New Media, Andrew Billings (and 16 students) watched all 348 hours of prime-time TV coverage of the 1998, 2002, and 2006 Winter Olympics and the 1996, 2000, and 2004 Summer Olympics. Why?

The objective of providing this longitudinal perspective is to highlight long-term gender trends within this very prominent sportscast by isolating men’s and women’s Olympic clock time in six consecutive Olympics. In doing so, the study underscores how the Olympic telecast itself is changing over time in terms of spotlighting different events.

The results demonstrated a slight overall advantage for coverage of male over female athletes in the Summer Games (51.9% vs. 48.1%) which was only significant in 2000. In contrast, coverage of male athletes in the Winter Games was significantly greater in all three years (overall 61.6% male vs. 38.4% female). Note that pairs events (such as pairs figure skating) were excluded.

For the Summer Olympics, the big three events for men were gymnastics (28.0% of the total male coverage), track and field (23.9%), and swimming (14.5%). For women, gymnastics (40.1%), track and field (16.9%), and diving (15.0%) had the greatest coverage. Although beach volleyball became an Olympic sport in 1996, the women's competition was only televised in 2004. In that year, the women had 2 hours of prime-time coverage, compared to only 1 minute for men's beach volleyball.

Swimsuits have become more modest (and aerodynamic) over time. Has that affected TV time?

1996 Olympic Swimming event in Atlanta

Possibly, although the article did not place the longitudinal changes in that context:

For men, the sports that gained coverage in the Summer Olympics were swimming and track and field (largely the result of network timeslot shifting in which these events moved from earlier time slots to within prime-time coverage).

Adapted from Tables 1 and 2 (Billings, 2008).

There was no such change in swimsuits in the diving events, however. If anything, men's swimsuits are more skimpy than the women's in this sport. Thus, it was notable that across all three Olympics, women's diving received 7 hrs 47 min coverage (15%) while men's received 4 hrs 34 min (8.2%).

These relationships are speculative. Let's read what the author actually said:

...the Summer Olympic events in which men were more likely to be shown than women were basketball, cycling, swimming, track and field, and volleyball. While some predictions for these differences could be proffered (i.e., lingering effects of the “Dream Team” in basketball or Lance Armstrong’s effect on the world of men’s cycling), the results only speak to the significant clock time differences rather than the reasons for them.

In contrast, women were more likely than men to be shown in beach volleyball (rising from no coverage to a two full hours of clock time in 2004), diving, and gymnastics. While all of these sports could be viewed as the fairly attractive/graceful category that Kane (1988) outlined (with the possible exceptions of basketball and the field sports in track and field), it is interesting to note that all of the sports in which women received the majority of the coverage involved the wearing of swimsuits or leotards. One could presume that the same desire to highlight attractive athletes would result in a desire for attractive male athletes, yet Jones, Murrell, and Jackson’s (1999) analysis found that a very different dichotomy was at work, with sports journalists highlighting “pretty” females but “powerful” males.

So yes, sex sells. Or put in more formal terms:

While this study does not attempt to interpret the cognitive processes of NBC gatekeepers in determining what to show, three additional propositions can be offered.

. . .

Second, attractive sports, such as beach volleyball, appear to be on the upswing, specifically for women. While men received more coverage in beach volleyball in 2000 than they did in 2004, women’s coverage increased exponentially. Part of this was likely the result of a highly skilled team, Misty May and Kerri Walsh, who won every match all year en route to a gold medal. Still, one has to note that part of the appeal of showing this event more frequently could reside in showing attractive women in swimsuits. The sexualized male gaze imparts a double standard within clock time differences, as the percentage of men athletes in sexualized situations (i.e., swimsuits/leotards) is not on the upswing nearly as much as for the women athletes.

Analysis of all 348 prime-time hours of the 1996—2006 Olympic telecasts (three Summer, three Winter) pinpointed trends in coverage of men's and women's sports. Results indicate that while men athletes and events received the majority of clock time in all six Olympic telecasts, the Summer Olympic telecasts treated women far more equitably than the Winter Olympic telecast. The longitudinal study does not offer any reason to feel that coverage of women's athletics is improving over time, finding that the proportion of clock time devoted to men's and women's sports is relatively the same in 2006 compared to ten years earlier.

12:45. Restate my assumptions.1. Mathematics is the language of nature.2. Everything around us can be represented and understood through numbers.3. If you graph the numbers of any system, patterns emerge; therefore, there are patterns everywhere in nature.

Maximillian Cohen is a mathematical genius in Pi, an intense psychological thriller directed by Darren Aronofsky in 1998. Max is a number theorist and human calculator who is searching for patterns in the stock market because it presents the greatest intellectual challenge.

"Millions of human hands at work, billions of minds...a vast network, screaming with life: an organism. A natural organism."

He suffers from debilitating migraine headaches and more than a little paranoia. Money is irrelevant to Max, but not to the aggressive and menacing agents from a Wall Street firm who insist upon hiring him. He is also followed around by a Hassidic Jew who adheres to the mystical beliefs of Kabbalah and especially Gammantria (or Gematria), a form of numerology that uses mathematics to unlock the secrets of the Torah.1 It's the belief that god really is a number.

In the movie, god is a 216 digit number that can also predict the stock market.

Max's mentor came across the number during his early research on π, but abandoned the effort after it resulted in a stroke. He tries to discourage Max from pursuing this work, but his advice is ignored, with disastrous effects. Max's health (and seemingly, his grip on sanity) declines to the point where he tries to rid his mind (and brain) of the migraines and the haunting numbers.

This artsy black and white film, shot on a very low budget ($60,000), employs an anxiogenic soundtrack to heighten the pain and disorientation of Max's migraines. The credit sequence alone is worth watching, and you can view it here. The image below is taken from one of the early PET papers by Petersen, Fox, Posner, Mintun, and Raichle (1988).

In 1988 an obscure paper was published–in a prominent, rigorous, indeed premier, scientific journal–with results that may demolish the claims of the "higher" critics, and support, rather, the Orthodox Jewish contention as to the nature of the Torah. The paper, by Doron Witztum, Eiyahu Rips and Yoav Rosenberg of the Jerusalem College of Technology and the Hebrew University, is innocuously entitled "Equidistant Letter Sequences of the Book of Genesis" and was published in the eminent Journal of the Royal StatisticalSociety. It generated a brief flurry of public attention (and a wave of activity within Orthodox Jewish circles) but was ultimately lost from general view both because of its rather technical nature and because of the sheer outrageousness of its findings, which remain, however, unrefuted as far as I know.

The authors, mathematical statisticians, discovered words encoded into the Hebrew text that could not have been accidental–nor placed there by human hand.

After publication, the authors continued their work and found that some pairs of words were predictive–that is, they could not have been known to the supposedly human authors of the Hebrew text because they occurred long after the Bible was composed.

The truth is, however, that with enough permutations, one can find such "prophetic" messages in any lengthy text... [including Moby Dick, which predicted the death of Princess Diana and the assassinations of many public figures].

. . .

Meanwhile, the May 1999 issue of Statistical Science ... included a refutation by four statisticians, who wrote that "despite a considerable amount of effort, we have been unable to detect the codes."

Tuesday, August 12, 2008

God is a dollar number according to those who run megachuches. It's impossible to know just how large that number might be for corporations such as Crystal Cathedral, since they failed to disclose their finances to MinistryWatch, an online database of Christian Ministries which charts financial transparency (for the benefit of potential donors):

We hope that by providing high quality research and ratings we will be a vital component in an emerging ministry marketplace, where information regarding various giving opportunities can be easily and efficiently transferred to eager, prepared donors.

Crystal Cathedral Ministries was created as a preaching and speaking church platform for Rev. Robert H. Schuller. In addition to being the home base for broadcasting the church services around the world on "The Hour of Power," the Crystal Cathedral campus is a place where thousands of persons "network" daily to find strength of body, mind and soul. Support groups, Sunday School classes, week day and evening gatherings provide fellowship with other persons of a positive faith. This ministry has chosen not to be open and transparent with MinistryWatch.com. As such it is difficult to understand all aspects of its ministry.

equipping Christians around the world to learn, apply and teach financial principles allegedly based on the Bible [according to Wikipedia, which also notes Crown's insistence that getting out of debt is an important part of Christian discipleship].

God is using Crown Financial Ministries around the globe to teach His financial principles and transform lives.

God has financial principles? Really? Count me among the skeptics... until I read these inspiring testimonies:

Having just finished the Crown Financial life group, I have already paid off two of our credit card debts and am working on a third. Thank you for this information. It is so very inspirational and practical with its application. The Web helps are so easy to understand and use. Thank you for letting God use you.

And this, from Jenna:

As for the lessons and homework, my whole perspective has changed on how to live life financially, and in other ways also such as honesty and work. I now know that my money is actually God's money. How God wants me to spend His money has impacted my spending. Learning that God created work and that He established every authority over us has made me appreciate those things much more.

It's easy for the smug scientific atheist to ridicule such ideas. But not all Christians are convinced of God's financial plan; there have been some vocal critics. Nathan Smith, for example, doesn't agree. In Crown Financial Manipulation, he states that Crown embellishes the gospel.

They subtly push their agenda by over-emphasizing finances at the expense of keeping the message of the gospel message unaltered.

And as for Paying It Forward...

Another thing that did not sit well with me is the way Crown emphasizes “investing” in the Kingdom. Yes, I tithe. I do think it’s very important to financially support the Church. The way they talk about it though, you’d think we were playing the stock market.

Christ never really talked about your 401k package… he did tell one wealthy young dude, who did pretty dang good at keeping all the commandments, to sell all his posessions…

But Christ was wrong. At the heart of the unchristian financial principles taught by Crown Financial is the view that welfare recipients are lazy and not deserving of assistance.

The failure of welfareMost Christians favor caring for those who truly are in need of help. However, most Christians also recognize the abuses and excesses in the current welfare system, evidenced by children in $100 running shoes, whose families are supported by government welfare and food stamps, and men who father children and are nowhere to be found when it's time to support their children.

So, although most Christians agree that, from a biblical perspective, it is not only important but it is mandated to care for the poor, the involuntary transfer of wealth from one group of taxpayers to another is not the type of care that God had in mind.

So don't give the needy any unearned handouts, save your money for your own family. But most importantly, donate to Crown. And be creative! Creative giving options include

A manifestation of Chinese superstition in Hong Kong is the common desire to avoid certain numbers and to engage others. Hospitals, along with most hotels and many other buildings, often do not label “fourth” floors and sometimes “fourteenth” floors because the number “4” and the word “death” sound almost identical in Cantonese and Mandarin…

Studies have suggested that cultural beliefs, such as those underlying religious social occasions and superstitions, have both positive and negative effects on mortality rates. Many people in Southern China believe that there are wandering ghosts who were released from hell during the lunar month of July ... people therefore avoid unnecessary risky activities during ghost month. The aim of this study was to examine whether unintentional drowning deaths decreased during ghost month, using a matched control design and mortality data of Taiwan between 1981 and 2005. ... The mean number of deaths in ghost months was lower than that in the matched controls... The differences were more prominent in men than in women. ... Possible mechanisms are that people who believe in the ghost month might either decrease their exposure to water-related activities or involve themselves less in risky behaviours during ghost month, as a kind of risk compensation, consequently resulting in a reduction in the number of drowning deaths.

HP: I used a hand trepan initially, but that wasn't proving to be terribly successful. Then there was a problem with the people who owned the property we were staying in, so we decided we'd have to just leave it. I wrapped my head up in a towel and we got out of there. A couple of days later, we had another go. We abandoned the hand trepan and got an electric drill instead. I injected myself with a local anaesthetic and then slashed a big T-shaped incision in my scalp, right down to the bone. I was sat there in the bathroom feeling quite relaxed and they started with the drill. It didn't take that long at all, probably about 20 minutes. Eventually I could feel a lot of fluid moving around. Apparently, there was a bit too much fluid shifting around, because they'd gone a little bit too far and I was leaking some through the hole, but this wasn't especially dangerous as there are three layer of meninges before you get to the brain.

Sunday, August 03, 2008

A number of fellow bloggers and friends have recently received appeals from seemingly unscrupulous individuals at for-profit startups and more established websites "to join their rapidly growing network of bloggers." In other words, they are trying to recruit bloggers to provide free content for their companies so the owners can make a profit.

My Name is Mark Lyall, Psy.D. and I am a segment producer for The Psychological Channel. The Psychological Channel is a new website: www.thepsychologicalchannel.com that will be launching on or about September 1, 2008. This site will be streaming videos from various sites (youtube, Google video, etc.) that were hand picked for their educational, therapeutic, or scientific value. If you have a video on a topic, send us the name and the site it is hosted on. If you have a video and need assistance uploading it, feel free to contact me. The Psychological Channel will also have articles on different topics having to do with psychology (blogs), and a message board. We contacted you because we are looking for high quality content. Please feel free to submit any written material as a blog on any topic within your area of expertise. Materials that have already been published can only be used if what you send would constitute a different version of material than what has been previously published, so as not to be a copyright infringement [because he wants to own the copyright, apparently]. If you have students that you feel have done an outstanding job on a topic, have them submit it to us for a blog.

We are not looking for videos or blogs that advertise a service, however if they meet our criteria of having scientific or educational merit they may includes contact information.

After September feel free to participate on our message board.

If you have any questions feel free to contact me at:Mark@Thanks for your attention.

Sincerely

Mark Lyall, Psy.D.Segment ProducerThe Psychological Channel

Changing the world through communication

OK, so he wants to reaggregate videos from other sites and feature blog posts by unpaid writers and students. For what? For free!! (and perhaps for promoting his seminar, Collective Momentum).

Maybe The Neurocritic is being too harsh here. The Psychological Channel hasn't even launched yet. He did expressly state that "We are not looking for videos or blogs that advertise a service" (at least in his appeal for writers and contributors).

It may turn out that The Psychological Channel will be a legitimate website that does not push an expensive 3-day seminar claiming to jumpstart your life by providing you "with the momentum to rewiring your brain the way that you want to have it wired."

But just call me jaded after reading the pitch from Dr. Geoff, who at present runs a chaotic site on Wellsphere called Dr. Geoff's MedBlog. The topics currently include plastic surgery, the Happiness Project, a long and highly technical review article on Lyme disease, dental hygiene, the treatment of Chiari malformation (with a case study on "Chiari syncope"). God knows who the audience is supposed to be.

On the WellMix 360beta page for occipital lesion, bizarrely, my recent post on the neural correlates of compulsive hoarding comes up as link number two under blogs on the right hand side:

The post didn't have anything to do with occipital lesions at all! There's most definitely a splog-like aspect to some of the pages, including some that are obscene, others that are just funny (disco malaria and disturbed lyric). With this cursory knowledge base in mind, here's the pitch.

Geoffrey W. Rutledge MD, PhD wrote:

Hi Blogger,

I was searching for the best medical bloggers when I discovered your blog at http://a blog dot com. I want to tell you I think your writing is great. My name is Dr. Geoff Rutledge, and I've taught and practiced Internal and Emergency Medicine for over 25 years at Harvard and Stanford medical schools. I'm also the Chief Medical Information Officer at Wellsphere (www.wellsphere.com), where we are building a network of the web's leading health bloggers, and I think you would be a great addition.

Wellsphere is a fast growing, next-generation online platform that is revolutionizing the way people find and share health and healthy living information and services. Our platform connects millions of users with the valuable insights and knowledge from health leaders and knowledgeable [GULLIBLE AND UNPAID] writers like you [WHO WILL PROVIDE FREE CONTENT ON OUR FOR-PROFIT WEBSITE].

We are now launching a new health community on Mental Health, and I would like to invite you to be a featured blogger for this community. By joining our network of hundreds of leading health and healthy living bloggers, you will be in great company, and will benefit from exposure to the expanded audience of the Wellsphere community. When you join, we also will feature you on our very popular WellBlog (http://www.wellsphere.com/blog.s), with a link back to your blog.

We will republish the postings you've already written for you, and feature them not only on the Mental Health community pages of the site, but also within a new dynamic magazine-like Wellsphere360 section, where we give users a comprehensive view of expert information, news, videos, local resources, and member postings on topics you write about. Your profile page on the site will give you special status as a featured blogger in the Mental Health community. If you are an active contributor, we also will feature you on our homepage at www.wellsphere.com.

By connecting to the Wellsphere platform, you will greatly expand the audience for your postings and attract additional readers to your blog. Also, your posts will link back to your blog, so you will benefit from Wellsphere's high ranking and large readership interested in your topic, which will give you more traffic, additional relevant audience, and a higher ranking for your blog.

If you would like to be a featured blogger in the Mental Health community, just send me an email to Dr.Rutledge@wellsphere.com. You can see a sample of a Wellsphere360 special section at http://www.wellsphere.com/Wellsphere360/diabetes-type-2.htm

Wellsphere, eh? You don't have to dig very far to find the dirt on that company. Let's start with Valleywag (Silicon Valley's Tech Gossip Rag) and a post titled Failure(from Tue Jul 31 2007):

Wellsphere, an Internet-health startup, gets the velvet-glove treatment from TechCrunch — and a savage expose from Uncov [i.e. Ted Dziuba]. An ex-employee emails Valleywag to add this about Wellsphere CEO Ron Gutman: "The most despicable human being I've ever come into contact with."

Let's review: you throw a big launch party, stick a video on YouTube, have the same positive and upbeat posters on VentureBeat and TechCrunch, and have a Website full of bugs and limited functionality…

This is professional PR management and not true grass roots community excitement over an innovative and exciting site. Look elsewhere folks. You're being taken advantage of.

You can also read a number of comments from disgruntled former employees and warnings against being conned by the CEO. The most succinct:

...It's a catastrophic failure of a "wellness portal", done up in the typical Web 2.0 fashion. However, all of the busting we've done on Wellsphere has been on its management team, whose collective business incompetence borders on mental defect.

. . .

July 30, 2007: We smack Wellsphere's shit down after sitting down to lunch with a bunch of informants. Same day: one of our readers finds a bunch of XSS holes in Wellsphere. Much win is had by all. Next day: The second part of Uncov's punishment of Wellsphere goes live. August 2, 2007: Wellsphere's psychopathic management team raids the comments on both Uncov articles, and a quick post at our prison-bitch site, Valleywag...

What's a blogger to do when receiving a request to join such a network? The Assertive Cancer Patient (Jeanne Sather) has a great post where she reproduces a series of e-mails, including Dr. Geoff's pitch and her initial reply. It's rather amusing. Here's how she introduces the exchange:

Every so often, I get an e-mail from someone who is starting up a new Web site and wants to use the content of my blog, for free.

I'm always pretty amazed by these folks--they want to use my blog, which I've spent countless hours writing, and not compensate me for it. This is my intellectual property, after all. It's how I make my living.

Their pitch usually includes something about how MY blog will benefit from the wider readership of THEIR Web site, but in fact, the reverse is probably true: Their Web site would benefit from having my content.

So I always say no, but, just for fun, I always tell them first that I'm willing to discuss it if they are willing to pay. I think a retainer of $3,000 a month is about right for the use of any and all content on my blog.

$3,000 a month sounds about right to me... NeuroValleywag, are you listening?

ADDENDUM: The Psychological Channel and Wellsphere are not related in any way. Just thought I'd clear up any confusion on the matter, in case that was unclear in this post.

About Me

Born in West Virginia in 1980, The Neurocritic embarked upon a roadtrip across America at the age of thirteen with his mother. She abandoned him when they reached San Francisco and The Neurocritic descended into a spiral of drug abuse and prostitution. At fifteen, The Neurocritic's psychiatrist encouraged him to start writing as a form of therapy.